Pekka Jylhä1, Tom Rosenström2, Outi Mantere1, Kirsi Suominen3, Tarja Melartin1, Maria Vuorilehto1, Mikael Holma4, Kirsi Riihimäki5, Maria A Oquendo6, Liisa Keltikangas-Järvinen2, Erkki T Isometsä7. 1. Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland. 2. IBS, Unit of Personality, Work and Health Psychology,University of Helsinki, Helsinki, Finland. 3. Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; City of Helsinki, Social Services and Healthcare, Department of Mental Health and Substance Abuse, Helsinki, Finland. 4. Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland. 5. Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; Healthcare and Social Services, City of Järvenpää, Järvenpää, Finland. 6. Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA. 7. Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
Abstract
BACKGROUND: Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. METHODS: Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. RESULTS: Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. LIMITATIONS: Findings generalizable only to patients with mood disorders. CONCLUSIONS: Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.
BACKGROUND: Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. METHODS: Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. RESULTS: Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. LIMITATIONS: Findings generalizable only to patients with mood disorders. CONCLUSIONS: Among mood disorderpatients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.
Authors: Tom Rosenström; Tim W Fawcett; Andrew D Higginson; Niina Metsä-Simola; Edward H Hagen; Alasdair I Houston; Pekka Martikainen Journal: PLoS One Date: 2017-06-14 Impact factor: 3.240
Authors: Severino Bezerra; Amanda Galvão-de-Almeida; Paula Studart; Davi F Martins; André C Caribé; Paulo A Schwingel; Ângela Miranda-Scippa Journal: Braz J Psychiatry Date: 2017-01-09 Impact factor: 2.697
Authors: John J Söderholm; J Lumikukka Socada; Tom Rosenström; Jesper Ekelund; Erkki T Isometsä Journal: Front Psychiatry Date: 2020-04-17 Impact factor: 4.157
Authors: Anastacia Y Kudinova; Heather A MacPherson; Katharine Musella; Elana Schettini; Anna C Gilbert; Gracie A Jenkins; Lee Anna Clark; Daniel P Dickstein Journal: Suicide Life Threat Behav Date: 2020-08-31